Accessing safe, healthy and affordable food in areas of social and economic deprivation is becoming a real problem in parts of the UK. Nargis Kayani looks at the relatively new phenomena of 'food deserts'

Residents of Stepney in the inner-city borough of Tower Hamlets, East London, would probably agree wholeheartedly with the statement from the Social Exclusion Unit opposite, and will almost certainly have had first hand experience of the day-to-day problems of poverty, social exclusion and inequality. While other nearby districts, such as the Docklands, have prospered, high levels of social and economic deprivation have blighted Stepney. Consequently, many local shops have closed, creating an adverse impact on both the local environment and quality of life. For these residents simply accessing healthy, affordable food is fraught with difficulties.

Food poverty, which essentially deals with the ability of those on low incomes to attain or consume an adequate quality or sufficient quantity of food, is not a new concept. The concept of food or shopping "deserts", however, is a relatively new phenomena and has resulted, in part, from the trend for out-of-town shopping centres and large inner-city superstores, often situated considerable distances from residents.

For many years, the "victim blaming" approach has meant that the poor have been considered responsible for their lack of healthy lifestyles and diet. However, following the election of a Labour government, there has been a marked change in political opinion. Action plan strategies, such as those contained within Saving Lives: Our Healthier Nation and the strategy document from the Social Exclusion Unit, signify the shift in emphasis towards improving the governing factors impacting on food poverty and the environment within which people live.(1) These reports, and more importantly the ethos behind them, appear to herald a new era which recognises that the problems of poverty deprivation, social exclusion and inequality of health must be tackled through a holistic nationwide approach.

Stepney's existing Single Regeneration Budget (SRB) programme, along with European regeneration programmes such as Objective 2 and the East London and City Health Action Zone, has recognised that regeneration initiatives, both locally and nationally, need to address the problem of food poverty. This has resulted in support for small-scale initiatives in the area, such as a food co-operative, community gardens, a city farm and school breakfast clubs.

More recently, the SRB programme has sponsored food deserts research in the form of a case study examining food access problems in Stepney. The recognition of food access issues as a central component of poverty, which needs to be tackled through neighbourhood renewal, has yielded a serious and substantial commitment to help eradicate food deserts in Stepney. As a direct result of proposals arising from this research, the recently approved £56.6m initiative, "Stepney New Deal for Communities (NDC)", has allocated £250,000 for work on improving food access as part of its Healthy Living Programme. It is expected that match funding from European and other sources could double this.

Cynics may view the allocation of these resources as misdirected and many environmental health departments would argue that the money could be better spent on enforcement. However, these departments must recognise that there is a wider context to the provision of safe, healthy food, particularly in view of the BSE crisis, the GM food debate, the Lanarkshire E. coli O157 outbreak and the creation of the Food Standards Agency. It is worth noting that food poisoning cases kill significantly fewer people annually than food-related disease, such as coronary heart disease and colorectal cancers. It is recognised that the emergence of food deserts in areas of social and economic deprivation is a contributory factor to the widening gap in health inequalities between the rich and poor.4 Indeed, East London and City Health Authority figures confirm that East Londoners suffer poorer health on average than the rest of the country (27 per cent), and have an average Standard Mortality Ratio which is 38 per cent above the national average.

For diet-related diseases (closely associated with fruit and vegetable consumption) the picture is similarly grim. Cardiovascular disease is cited as the leading cause of preventable disease in those under 65, and diabetes rates are twice the national average.(2) The statistical evidence is quite uncompromising and has, in past years, lead to well-known national health education programme campaigns such as the heartbeat award. Such campaigns, although quite worthwhile, did little to tackle or even recognise the quite legitimate problems of accessing healthy food for those on low incomes.

The practical problems experienced by those struggling to survive on poverty level incomes are quite staggering. Research into food deserts has shown that residents in Stepney have to travel an average 1,285m to reach the only two green grocers situated in their area. This distance is more than two and a half times greater than the 500m distance (both to and from shops) that a report from the local health authority on food access deems acceptable.(3)

Stepney is an area characterised by low car-ownership and benefit-dependent residents, thus visiting the nearest supermarket and market can be a struggle both physically and financially. For many, this means using public transport to visit the nearest shop, which can be expensive, physically difficult and time consuming.

There are further problems linked to the outlets themselves. The pricing and packaging policies of the larger stores make simple price comparisons almost impossible. The low-cost European stores sell pre-packaged goods at fixed prices and cater for the bulk shopper. Smaller, local shops usually have a limited selection of produce, which is often poor quality, at higher cost.

There is little doubt that the solutions to the diverse problems of accessing healthy, affordable food for those on low incomes in areas of poverty and deprivation are both varied and complex. Raising household income levels, whether by encouraging benefit take-up campaigns or by assisting individuals to gain employment, undoubtedly forms a central part of any strategy to improving financial barriers to food access. However, for some individuals, the elimination of physical barriers should be the priority. In some instances this means that local food co-operatives are the solution, but they must be run in an economically viable and sustainable way and serve all sectors of the community. In other cases, where residents have expressed a desire to be able to access existing shops, then sustainable community transport initiatives have to be considered by local authorities and local transport providers.

The potential for exciting and effective local partnerships with EHOs is a real possibility but a concerted effort is needed at all levels - from voluntary organisations, community groups, retailers, health providers, academics, regeneration agencies, schools, youth clubs, politicians, and the media. All these groups have a vital role to play in ensuring that malnutrition and hunger, the scourges of poverty often associated with poorer nations, are not allowed to proliferate in our inner cities.

References
1. Department of Health (1999) "Saving Lives: Our Healthier Nation", White Paper, 1999, HMSO.
2. East London & City Health Authority (ELCHA 1999) Health in the East End - Annual Public Health Report 1999/2000, ELCHA, June, 1999.
3. Frize J (1999) Food Access in East London, ELCHA, September 1999.
4. Lang T & Caraher M (1998) Access to health foods part II. "Food poverty and shopping deserts: what are the implications for health promotion policy and practice?" Health Education Journal 57 p.202-211, 1998.
5. Social Exclusion Unit (2000) National Strategy for Neighbourhood Renewal: a framework for consultation. Report by the Social Exclusion Unit, April 2000, Cabinet Office.

This paper is a summary document of the BSc (Hons) Environmental Health thesis by Nargis Kayani, a copy of which is held at the University of Greenwich Library. E-mail: nargis_kayani@hotmail.com

A report highlighting the main research findings from the thesis is due to be published by Stepney SRB in December 2000. For copies please contact Mark Adams, central Stepney SRB co-ordinator. Tel: 020 7364-4458.